ÖGDV presents new risk-based recommendations for skin cancer prevention

First author Peter Kölblinger works at the University Clinic for Dermatology and Allergology Salzburg of the Paracelsus Medical Private University Salzburg. Together with other experts, he developed the new tiered concept, which is to apply from now on. It provides that adults from age 18 attend a dermatologist once for an assessment of their melanoma risk.

ÖGDV Vice President Franz Trautinger, head of the Department of Dermatology and Venereal Diseases at the University Hospital St. Pölten, justified the turnaround with scientific findings of recent years. „Vielmehr gab es in den vergangenen zehn Jahren zunehmend Publikationen, die die Sinnhaftigkeit eines ungezielten Screenings in Frage gestellt haben", sagte Trautinger. „Internationale Studien konnten nicht zeigen, dass durch ungezielte Screenings und Vorsorgeprogramme die Sterblichkeit durch Hautkrebs gesenkt werden konnte."

Previous practice and international comparison

Until now, it was common practice in Austria that insured persons could go for skin cancer screening regularly without their personal risk playing any role. Germany is an exception in Europe: there, those with statutory health insurance can undergo screening every two years from age 35. The ÖGDV now sees an opportunity for Austria to take a smart middle way.

In detail, the new model provides that persons with an elevated melanoma risk undergo close medical monitoring. This includes people with more than 60 acquired moles, more than four atypical moles, or melanomas that have already occurred in the past. Familially clustered melanomas, a previous actinic keratosis, a squamous cell carcinoma or basal cell carcinoma, as well as a previous organ transplantation also increase the risk. If there is no elevated risk, no further routine medical examinations for the early detection of skin cancer should be carried out up to the age of 50, apart from the recommended self- and partner examinations.

Who is considered a risk patient?

Because the risk of skin cancer rises with increasing age, closer medical monitoring should resume between the age of 50 and beyond. The basic examination at age 18 serves to classify the personal risk for the first time and to determine the further prevention pathway. „Besteht ein niedriges Risiko, sollen abseits der empfohlenen Selbst- und Partneruntersuchungen bis zum 50. Lebensjahr keine weiteren routinemäßigen ärztlichen Untersuchungen zur Hautkrebsfrüherkennung durchgeführt werden", erläuterte Peter Kölblinger.

Despite the shift away from blanket screenings, the professional society emphasises that self- and partner examination in adults aged 18 and over remains the most important pillar of early detection. „Die wichtigste Vorsorge beginnt viel früher: beim Schutz vor übermäßiger UV-Strahlung und bei der Aufmerksamkeit für Veränderungen der eigenen Haut", wurde Franz Trautinger zitiert.

Primary prevention remains central

Primary prevention remains high on the agenda according to the ÖGDV. Recommendations include sun protection through clothing, sunscreen with a sun protection factor of at least 30, and avoiding the midday sun two hours before and after the sun's highest point. Direct sun should be avoided between 11 a.m. and 3 p.m. The quantity also matters: after a week of summer holiday, a 200-millilitre tube of sunscreen should be used up.

Manfred Fiebiger, federal specialist group chairman for Dermatology at the ÖGDV, summed up the professional society's concern in a catchy formula. „Es bedeutet die richtige Medizin für die richtigen Menschen zur richtigen Zeit", sagte Fiebinger. „Die Hautkrebsvorsorge soll nicht nach dem Gießkannenprinzip erfolgen, sondern nur bei jenen, die es wirklich brauchen." At the same time, he assured: „Risikobasiert bedeutet nicht weniger Medizin."

The background to the recommendations is also the epidemiological situation: around 400 to 450 people in Austria die of melanoma each year. Melanoma, or black skin cancer, can form metastases in 2 to 5 percent of cases, especially in the lymph nodes. The ÖGDV justifies the departure from universal screening by the fact that untargeted screening has not produced any measurable reduction in mortality in studies.

Open points and next steps

How the risk assessment will work in concrete terms in future has not yet been clarified in all details. „Es geht um bessere Orientierung unserer Maßnahmen", sagte Trautinger. Dermatologists, general practitioners, social insurance, the ministry, the Medical Chamber, cancer aid organisations and patient representatives are to work together on a nationwide model. The ÖGDV sees an opportunity for Austria to take a smart middle way.

One open question is also the use of smartphone apps for self-examination. Peter Kölblinger pointed out that there have so far been no large studies confirming their accuracy and reliability. „Das Problem der Apps ist, dass es keine großen Studien gibt, die Genauigkeit und Verlässlichkeit bestätigen. Wir geben daher zum jetzigen Zeitpunkt keine eindeutige Empfehlung", betonte Kölblinger.

The professional society also emphasises that the population needs to be educated more strongly about melanoma risk and about proper UV protection. Especially on the topic of UV protection, there is still „Luft nach oben"; many people do not know what damage they inflict by sunbathing. Trautinger summarised the new approach as follows: „Und wer kein erhöhtes Risiko hat, soll wissen, worauf er oder sie selbst achten kann und wann ärztliche Hilfe notwendig ist."

What the new recommendation means for patients

Overall, responsibility for early detection is shifting more towards each individual, without neglecting the medical care of risk patients. The ÖGDV sees the new model as a contribution to modern, evidence-based cancer prevention that pools available resources where they bring the greatest benefit. The coming months will show how social insurance and policymakers implement the model in practice.

In conclusion, the ÖGDV stressed that even with a low risk, any skin change that is noticed should be medically examined without delay. Self- and partner examination remains a central building block, supplemented by targeted medical checks for people with an elevated risk. The aim is to make skin cancer prevention in Austria more precise and more effective.